RT Interpreter: Best practice medicine

So, I've written about Best Practice Medicine. This is where what we do in the hospital is based on what works best in a certain situation for a certain diagnosis.

This actually sounds good on the surface. The Committee of Medicare/Medicaid Services (CMS) came up with it's core measures with the intent on making sure patients were getting the best care possible.

Well, not really. Core measures, and best practice medicine, are basically nice ways of saying: "We don't want to pay as much as you are asking." We don't want to reimburse your costs.  And when I say "we" I'm referring to the government.

Now let's run reimbursement through our interpreter: Less reimbursement means the government pays less, but the hospital pays more.

I'll give you an example. Our new chest pain protocol, which is based on best practice medicine, calls for an initial EKG within 10 minutes, another in 2 hours, and another in 2 hours after that, and another in the morning.

We have to do these things whether they are needed or not. So basically we are treating all patients out of the same cookbook. Doctor discretion and common sense have taken a back seat to the cook book written by someone in Washington.

Now don't get me wrong, I think the idea of core values and best practice medicine are a good thing, and I think protocols and policies that have come of them are good for the most part. Yet with the government setting the table, innovation is stymied and costs of medicine skyrocket.

Think of it. A doctor gets $30 for every EKG he interprets. So now we are doing three times the number of EKGs because of best practice medicine, so now we need to come up with not only the money to pay the doctors, but pay the technician to do the EKG. And, not to mention, more EKGs will mean the machines won't last as long, so there's the replacement and upkeep price tag that gets overlooked too.

Of course we have to come up with all this money, while the government and HMOs pay a flat fee for services based on the diagnosis (DRG).  The government saves yet the hospital loses. 

There's some good of all this, yet you can see why the bottom line is not to benefit the patient but to make sure Uncle Sam doesn't have to pay too much.

Yet since we chose to have Uncle Sam pay the bills, we also inadvertently chose to have fewer freedoms in the process.